中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (1): 108-111.doi: 10.3969/j.issn.1673-8225.2010.01.023

• 干细胞移植 • 上一篇    下一篇

冠状动脉搭桥与骨髓CD34+细胞移植后心肌血流灌注及细胞代谢
双核素显像评价

张国旭，郝珊瑚，王治国，张 彤，王辉山，陈宪英   

  1. 解放军沈阳军区总医院核医学科，辽宁省沈阳市 110016
  • 出版日期:2010-01-04 发布日期:2010-01-04
  • 作者简介:张国旭，男，1973年生，辽宁省沈阳市人，汉族，1998年苏州大学核医学院毕业，硕士，副主任医师，主要从事核素分子影像方面的研究。 zhangguoxu502@sina.com
  • 基金资助:

    解放军沈阳军区总医院2008年度重点基金课题。

Myocardial glucose metabolism and perfusion following coronary artery bypass grafting and bone marrow CD34+ cell transplantation: Dual-isotope imaging evaluation

Zhang Guo-xu, Hao Shan-hu, Wang Zhi-guo, Zhang Tong, Wang Hui-shan, Chen Xian-ying   

  1. Department of Nuclear Medicine, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang   110016, Liaoning Province, China
  • Online:2010-01-04 Published:2010-01-04
  • About author:Zhang Guo-xu, Master, Associate chief physician, Department of Nuclear Medicine, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang 110016, Liaoning Province, China zhangguoxu502@sina.com
  • Supported by:

    the Major Program of General Hospital of Shenyang Military Area Command of Chinese PLA in 2008*

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摘要：

背景：对于没有心肌存活的梗死区域或心肌梗死区域占心脏很大部分的患者，冠状动脉搭桥的疗效并不明显；当前利用各种干细胞实现心肌和血管的再生已成为缺血性心血管疾病研究热点，移植后心肌的存活与血流灌注的改善有直接关系。

目的：应用18F-FDG和 99双核素显像评价陈旧性心肌梗死患者经冠状动脉搭桥的同时，选择性行自体骨髓CD34+细胞移植后的心肌血流灌注及细胞代谢情况。Tcm-MIBI

方法：术前1 d于患者髂前上嵴抽取骨髓，Ficoll法密度梯度离心骨髓单个核细胞，应用磁珠分离系统分离纯化CD34+细胞。全麻下检查患者冠状动脉病变情况，行移植物血管和冠状动脉的端侧吻合，然后抽取浓度为1×1011 L-1的骨髓CD34+细胞悬浊液，在梗死灶(血流/代谢匹配性缺失处)周边及中心6点分别注射，每点注射0.2 mL。根据术前灌注/代谢显像结果，将心肌节段分为匹配和不匹配两类：①匹配类型：血流灌注和代谢显像均稀疏缺损或均正常，即梗死心肌或正常心肌。②不匹配类型：血流灌注显像稀疏缺损，而代谢显像正常或有放射性分布，即存活心肌。移植前后行18F-FDG及99Tcm-MIBI双核素显像，通过圆周剖面半定量分析，评价冠状动脉搭桥和干细胞移植对心肌灌注及代谢的影响。

结果与结论：31例患者共分为279个节段。不匹配组145个节段，与术前比较，术后4个月99Tcm-MIBI及18F-FDG摄取分数均显著增加(P < 0.01)；匹配非移植组81个节段，与术前比较，术后4个月99Tcm-MIBI及18F-FDG摄取分数均无明显变化(P > 0.05)；匹配移植组54个节段，与术前比较，术后4个月99Tcm-MIBI及18F-FDG摄取分数均显著增加(P < 0.01)。冠状动脉搭桥只能改善有存活心肌细胞梗死心肌的血流灌注及细胞代谢，而自体骨髓CD34+干细胞移植能够改善无存活心肌细胞梗死心肌的血流灌注及细胞代谢。

关键词: 干细胞移植, 冠状动脉搭桥, 18F-FDG, 99Tcm-MIBI；显像

Abstract:

BACKGROUND: For patients with myocardial infarction occupied most of the heart, the effect of coronary artery bridge is not obvious. Currently, myocardial and vascular regeneration by stem cells has become a focus of ischemic cardiovascular disease. Myocardial survival directly correlates with improvement of blood perfusion following stem cell transplantation.

OBJECTIVE: To investigate the feasibility of 18F-FDG and 99Tcm-MIBI single photon emission computed tomography imaging in assessing myocardial glucose metabolism and perfusion with old myocardial infarction after coronary artery bypass grafting (CABG) and CD34+ stem cell transplanting.

METHODS: Bone marrow was extracted from the anterior superior iliac spine 1 day before surgery. Mononuclear cells were isolated by Ficoll density gradient centrifugation. CD34+ cells were isolated and purified by immunomagnetic bead system. Coronary artery pathological changes were examined under general anesthesia. The end-to-side anastomosis of graft vessel and coronary artery was performed. 1×1011/L CD34+ cell suspension was extracted, and injected into the surrounding and center of the infarct (blood flow/metabolism matching depletion) at 6 points, with 0.2 mL in each point. According to preoperative perfusion/metabolism imaging, myocardium segments were divided into two groups: match group: blood perfusion and metabolism images were sparse or normal, i.e. infarction or normal myocardium; mismatch group: blood perfusion image displayed depletion, but metabolism images were normal or radially distributed, i.e. surviving myocardium. 18F-FDG and 99Tcm-MIBI dual-isotopic imaging were performed before and 4 months after CABG. Circumferential count profiles from 18F-FDG and 99Tcm-MIBI short axis slices were generated to assess myocardial blood perfusion and glucose metabolism.

RESULTS AND CONCLUSION: The 31 patients were divided into 279 segments, and 145 segments were in myocardial perfusion–metabolism mismatch (MM). 99Tcm–MIBI and 18F-FDG uptake fraction was significantly increased 4 months before operation (P < 0.01); match group without transplanting had 81 segments, and the 99Tcm–MIBI and 18F-FDG uptake fraction remained unchanged after operation (P > 0.05). Match group undergoing transplanting had 54 segments, and their 99Tcm–MIBI and 18F-FDG uptake fraction increased remarkably 4 months after operation (P < 0.01). CABG can improve the function of survival myocardial segments, but it is helpless to infraction myocardium. The autologous CD34+ stem cell transplantation can improve myocardial blood perfusion and glucose metabolism of the distributions of infract myocardium.

 

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